The natural history of post-traumatic hypopituitarism: implications for assessment and treatment

Purpose

Hypopituitarism has been reported in up to half of long-term survivors of traumatic brain injury. We attempted to define the natural history of post-traumatic hypopituitarism to devise guidelines for the optimal timing of patients’ assessment and hormone replacement.

Subjects and methods

Fifty consecutive patients with severe or moderate head trauma were enrolled in a prospective study of pituitary function during the acute phase, at 6 months, and at 12 months after injury. Growth hormone and adrenocorticotropin hormone reserves were assessed using the glucagon stimulation test. Baseline serum concentrations of other anterior pituitary hormones were measured. Results were compared with normative data obtained from matched healthy controls.

Results

Nine patients (18%) had growth hormone deficiency in the acute phase; at 6 months, 5 patients recovered function and 2 new deficiencies were detected; at 12 months, 1 patient recovered, leaving 5 patients (10%) with growth hormone deficiency. Eight patients (16%) showed subnormal cortisol response in the acute phase; at 6 months, 4 patients had recovered and 5 new deficiencies were detected; all 9 patients had persistent abnormalities at 2 months. Forty patients (80%) had gonadotropin deficiency in the acute phase, of whom 29 (73%) recovered by 6 months and 34 (85%) recovered by 12 months. Thyrotropin deficiency was present in 1 patient in the acute phase, who recovered by 6 months; 1 new case was diagnosed at 6 months, which persisted at 12 months.

Conclusion

After traumatic brain injury, early neuroendocrine abnormalities are sometimes transient, whereas late abnormalities present during the course of rehabilitation. A follow-up strategy with periodic evaluation is a necessary part of the optimal care for patients with traumatic brain injury.     

血管内皮生长因子基因转染骨髓间充质干细胞移植促进缺血心肌血管生成的研究

目的研究血管内皮生长因子(vascularendothelial growth factor,VEGF)基因转染骨髓间充质干细胞(mesenchymalstem cells,MSCs)移植对缺血心肌的血管生成作用。方法于2004年5月至2005年8月取第四军医大学西京医院分离、培养Wistar大鼠的MSCs,用真核表达载体pcDNA3.1(-)/hVEGF165转染MSCs。45只近交系Wistar大鼠随机均分为转染组(MSCs/VEGF组)、对照组(MSCs组)、无血清培养基组(DMEM组),结扎前降支建立急性心肌梗死模型后在梗死区边缘区行5×106细胞移植,DMEM组行等量培养基注射。细胞移植前行CM-DiI标记。移植1个月后行心脏B超测量射血分数值,组织化学染色评价新生血管密度。结果培养的MSCs呈典型贴壁生长成纤维样外观,pcDNA3.1(-)/hVEGF165能有效转染大鼠MSCs,移植1个月后MSCs/VEGF组较其余各组左室射血分数(LVEF),再生血管密度明显增加,差异均有显著性(P<0.01)。结论VEGF基因转染MSCs移植能显著促进缺血心肌血管再生,进而改善心脏功能。     

去甲肾上腺素与哌唑嗪对高血压大鼠动脉平滑肌细胞Na~+-K~+-ATPase活性及mRNA表达的影响

目的观察去甲肾上腺素(NE)及其α1肾上腺素能受体(α1-AR)拮抗剂哌唑嗪(Prazosin)对自发性高血压大鼠(SHR)动脉血管平滑肌细胞Na -K -ATPase活性及mRNA表达的影响。方法采用生化酶学方法和逆转录聚合酶链反应技术,观察不同浓度的NE和哌唑嗪对自发性高血压大鼠血管平滑肌细胞Na -K -ATPase活性和mRNA表达的影响。结果与SHR组比较,NE(10-7mol/L)能减弱Na -K -ATPase活性(3·98±0·14vs7·92±0·19,P<0·01)及Na -K -ATPaseα1-亚单位mRNA的表达(0·863±0·057vs1·307±0·051,P<0·01),单用哌唑嗪对Na -K -ATPase活性及mRNA的表达均无影响(P>0·05)。哌唑嗪(10-7,10-6,10-5mol/L)呈剂量依赖性减弱和阻断NE(10-7mol/L)对Na -K -ATPase活性(4·31±0·24,6·15±0·30,7·52±0·31)及Na -K -ATPaseα1-亚单位mRNA表达(0·857±0·041,1·096±0·055,1·183±0·059)的影响(P<0·01,P<0·05)。结论NE抑制SHRNa -K -ATPase活性和下调Na -K -ATPaseα1-亚单位mRNA表达,可能是通过α1-AR途径介导基因转录的下调。肾上腺素能1型受体拮抗剂哌唑嗪可通过阻断α1-AR途径抑制NE对自发性高血压大鼠血管平滑肌细胞Na -K -ATPase活性和Na -K -ATPaseα1-亚单位mRNA表达的影响。     

Hepatic apoptosis and proliferation in male and female rats fed alcohol: role of cytokines

Background: The female liver is more sensitive to the toxic effect of chronic alcohol intake than the male liver. The aim of the study was to compare the influence of gender and sex hormonal status on apoptosis and cell proliferation following chronic ethanol intake.
Methods: Male and female rats were pair fed for 8 weeks a liquid diet containing 36% of their total daily calories as ethanol (ETOH group) or sucrose (control group). Liver samples were analyzed for apoptosis and hepatocyte proliferation by immunohistochemistry. The hepatic production of factors able to influence cell death and proliferation, such as tumor necrosis factor alpha (TNFα) and interleukin 6 (IL-6) were determined.
Results: In both male and female rats, ethanol intake promoted apoptosis in the liver. This effect of ethanol was more evident in female than male rat livers. Hepatic TNFα levels, which promote apoptosis, are significantly more elevated in female than in male livers. Hepatic IL-6 production, which promotes hepatocyte proliferation, was induced by ethanol only in males, but not female animals.
Conclusion: This observed difference in cytokine responses may contribute to the enhanced sensitivity of female liver to EtOH-induced injury.     

烟酰胺腺嘌呤二核苷酸磷酸氧化酶对血管疾病病理过程的影响

氧化应激是一种活性氧(ROS)代谢引起的分子失调,以一氧化氮生物利用度下降为特征。使用抗氧化维生素E和维生素C对心血管疾病无明显疗效,这使得对氧化应激的分子本质的理解产生了变化。氧化应激不再被认为是产生和消除ROS之间的不平衡,而是酶功能的异常,特别是烟酰胺腺嘌呤二核苷酸磷酸(NADPH)氧化酶功能的异常。因此,NADPH氧化酶已成为重要的治疗靶点。为了设计正确的抗氧化治疗方案,必须考虑NADPH氧化酶的分子调节作用,以及新型该家族人类同源物Nox1、Nox2、Nox3、Nox4和Nox5。通过发展和评估可靠的局部和系统抗氧化应激技术抑制NADPH氧化酶,可能比使用抗氧化剂非选择性消除所有ROS更加有效。     

舒血宁联合脑苷肌肽治疗血管性痴呆的疗效研究

目的 观察舒血宁联合脑苷肌肽治疗血管性痴呆患者的疗效及对精神行为症状的改善情况.方法 将58例血管性痴呆患者随机分为舒血宁联合脑苷肌肤治疗的观察组和单纯脑苷肌肤治疗的对照组,治疗结束后观察两组患者的临床疗效、简易智能量表(MMSE)、日常生活活动能力量表(ADL)评分以及安全性评价.结果 治疗后,观察组有效率为89.66％,优于对照组的72.41％,组间差异有统计学意义(P＜0.05).治疗后两组患者的MMSE、ADL评分均较治疗前明显增加,差异均有统计学意义(P＜0.05);而组间比较,观察组的MMSE、ADL评分均较对照组明显增加,差异亦有统计学意义(P＜0.05),且均未出现不良反应.结论 舒血宁联合脑苷肌肽治疗血管性痴呆患者,不仅疗效较佳,安全性高,而且可有效改善患者的精神行为症状.     

改良动静脉内瘘成形术120例临床疗效分析

目的：报道应用改良连续缝合加褥式缝合血管进行血液透析内瘘术的临床效果。方法：选取120例需行血液透析患者男55例,女65例,年龄24岁～75岁,行前臂标准位桡动脉头静脉侧端改良连续缝合加褥式缝合内瘘术,通过临床及超声随访验证。结果：手术成功率达99％,内瘘长期有效率达98．2％。结论：应用改良连续缝合加褥式缝合血管行内瘘术能够收到良好的临床效果。